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QUADRUPLICATE STATE OF CALIFORNIA W R USE ONLY - N T F I N <br /> •—rar-total Requirements WELL COMPLETION REPORT LL I I I I I I I <br /> Page 1 of 2 Refrr to Inrnuation Parrrpbin STATE WELL NO'STATION NO. <br /> Owner's Well No. No. I El ��'II <br /> Date Work Began S IS/96 —,. gd 5/15/96 475336 LAnTLmE LGNCTUDE <br /> an Local Permit Agency q n y V. O FAV. Health <br /> Permit No. Perm.( Dale I I <br /> GEOLOGIC LOC WE :O WNE P, <br /> ORIENTATION ( X VERTICAL — HORIZONTAL _ANGLE —(SPECIFY) Name f` HOrras II <br /> 2) I: Ir <br /> DEPTH FROM DEPTit TO FIRST WATER (Ft.) BELOW SURFACE Mailing Address �13 1�0 Corral Hollow <br /> SURFACEDESCRIPTION rAC]AA. 95376 <br /> FI. 10 FI. Derenbe materia(,grain use,color,etc CRY STATE ZIP <br /> O 80 Same eWF.LL LOCATION <br /> Address <br /> Y City <br /> crave County anaaqu n <br /> clay APN Book Page Parcel <br /> ce <br /> arAVe Township' Range Section <br /> f0Latitude NORTH Longitude west <br /> Y DEG. MIN. SEC. DEG. 1 MIN SEG <br /> Gravel LOCATION SKETCH ACTIVITY ( ), <br /> 62 64 ulzy NORTH X NEW WELL <br /> 64 P 71 czavn MODIFICATION/REPAIR <br /> 11 80 clay —Deepen <br /> 50 9 IT Gravel _Olaer(SPacay)I <br /> 4_ _.� �{ DESTROY(Deaccee <br /> Procetlmaa ens Mefai le <br /> Untler"GEOLOGICL '7 <br /> 104 108 Clay PLANNED USES <br /> 110 IN 3w 1 A <br /> Y C i _ MONITORING 1q <br /> WATER SgpPLY <br /> 121 1,73 <br /> Y _ Domearw C <br /> 173 <br /> JGravc)l PuMlc <br /> 145 AY ; _ Wi,ellan <br /> ave — InanMrla N <br /> 3:59 16lr >. -. . ..I f,p lu) .� _ .,TEST WELL <br /> 153 It) Jt_ ® _ _ CATHODIC PROTEP is <br /> SOUTH TION <br /> 1155 1() <br /> 7-1 AY Illaslrafe or Dexedlre DNlance of Well from La.d..'b, — OTHER(Specify) <br /> such art Road,Buildings.Fences.Ripen,eM. <br /> 111 169— uraval PLEASE BE ACCURATE & COMPLETE. ((� <br /> 169 112 Ay DRILLING MW rotary172 11-4 tJAttgr f <br /> 'd <br /> METHOD FLUID <br /> WATER LEVEL a YIELD OF COMPLETED WELL <br /> 1/4 ny DEPTH OF STATIC 170 5/21/96 <br /> WATER LEVEL (FI.) 8 DATE MEASURED <br /> ISO laz Avel (Cont'd to Page ESTIMATED YIELD (GPM) 6 TEST TYPE t <br /> TOTAL DEPTH OF PORING (Feel) TEST LENGTH_ (Hra.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) 'May not be represertmtive o/a w iff s long-terns yield. <br /> DEPTH CAS I NG(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE I FROM SURFACE TYPE <br /> DIA. z a: MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- REN <br /> (Incnee) oa"i GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> FL to FI. H _ (Incnee) THICKNESS (Incnee) FL to Ft MENT TDNITE FILL <br /> (�) (Z) (�) (TYPE/SIZE) <br /> ATTACHMENTS 141 CERTIFICATION STATEMENT <br /> Geologic Lop 1.the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief.' <br /> Calwater Drilling Co., Inc. <br /> Well Construction Diagram NAME <br /> (PE3SODN, FIRM OR TyDroy) (TYPED OR PAINTED) y�r1OCICr CA. 95380 <br /> _ Geophyelcel Log(a) N t• <br /> Soil Water Chemical Analyses I <br /> Other <br /> ADDRESS CITY STATE ZIP <br /> rBkkpr. 5/22/96 434218 <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed <br /> WELL DRILLER AUTHORIZED REPRESENTATIVE DATE SIGNED Cal LICENSE—NUMBER <br /> Own IMM BEV.Y�NI IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />